1. Field of the Disclosure
This disclosure relates generally to methods and devices for performing vascular and aortic surgery, and more particularly, to methods and devices for prosthetic replacement, bypass or access grafts that can be more ideally size-matched for both length and caliber to avoid unwanted native vessel and prosthetic graft distortion and related malfunction or complications.
2. Discussion of Related Art
Vascular obstructive and aneurysmal diseases are leading causes of morbidity and mortality in the United States and abroad. During surgery to replace, bypass or access diseased or dysfunctional blood vessels or vascular structures, the use of a prosthetic graft is often required. Most of the time, when one blood vessel is connected to another (or to another prosthetic vascular graft), a distance between the two vessels is merely estimated, often incorrectly. Over-estimation of a needed prosthetic graft length can lead to kinking and obstruction of the graft due to redundancy, which can lead to either early or late procedural complications. Under-estimation of prosthetic graft length can lead to tension on the vascular connections, leading to bleeding, distortion of recipient vessels, and late complications, such as pseudoaneurysms. Another miscalculation of needs can relate to over-estimation of prosthetic graft diameter. If the selected prosthetic graft diameter exceeds that of the recipient vessel in the setting of an intended “end-to-end” graft to vessel vascular connection, a size mismatch often leads to bleeding at the site of vascular connection. In addition, most vascular procedures will require at least two separate vascular connections, and these connections are generally visually hindered by the presence of longer segments of prosthetic graft material. The vascular connection becomes technically much easier with shorter (and shortest) graft lengths, due to better visualization and manipulation of the interaction of the prosthetic graft with the recipient vessel.
A prosthetic vascular graft has been conceived to overcome the aforementioned limitations of standard vascular prosthetic devices. Current devices are typically constructed of knitted or woven Dacron or polyester material, or of another material, such as polytetrafluoroethylene (PTFE). These devices are typically of a uniform caliber and length, and some newer devices can taper by increasing or decreasing to a different caliber, in a predetermined and non-adjustable fashion. Other common existing devices appear corrugated, and can be stretched from a static baseline length to a longer length by traction, or more commonly, graft length is increased in a somewhat less predictable fashion after it become pressurized with flowing blood after completion of the vascular connections. It is in precisely in these situations when incorrect estimation of “final” (pressurized) graft length becomes apparent, with grafts that are too long becoming kinked due to redundancy and grafts that have been purposely trimmed to be shorter (to avoid redundancy and kinking) turn out to be too short, with graft/vascular connections that are ultimately under tension in their final configuration.